Cueing-assisted gamified augmented-reality home rehabilitation for gait and balance in people with Parkinson disease: feasibility and effectiveness in the clinical pathway.

IMPORTANCE

Physical therapy is moving toward digitally supported, independent, home-based care to improve therapy accessibility and adherence.

OBJECTIVE

This trial evaluated the clinical feasibility and potential effectiveness of Strolll, an augmented reality (AR) neurorehabilitation platform offering gamified gait-and-balance exercises with optional assistive AR cueing for individuals with Parkinson disease, implemented in real-world clinical practice.

DESIGN AND

SETTING

In this pragmatic clinical trial, 15 Dutch health care practices were onboarded, 28 therapists trained, and 100 individuals with Parkinson disease (Hoehn and Yahr stages 1-3) included. All participants followed the T0-usual-care-control-T1-Strolll-intervention-T2 procedure.

INTERVENTION: The Strolll intervention consisted of 2-week supervised in-clinic training followed by 6 weeks, 5 sessions per week of 30 active minutes each, independent home-based training.

RESULTS

No serious adverse events occurred; only 2 non-injurious falls were reported in >60.000 exercise minutes. Adherence was high (96% session adherence, 91% active minutes/session adherence). Therapists prescribed the program progressively, with significantly higher game-play levels over time. Participants' exercise performance increased over time. Participants and therapists rated user experience and technology acceptance positively. Timed "Up & Go" test and 10-meter walk test (10MWT) (fast speed) scores improved significantly after the intervention period only. Five times sit-to-stand test, 10MWT (comfortable speed), and Mini Balance Evaluation Systems Test scores improved after both usual-care and intervention periods. Falls Efficacy Scale-International scores showed no significant improvements. AR cueing was deemed beneficial for a subset of participants.

CONCLUSIONS

Strolll is a safe, adherable, progressive, usable, and well-accepted therapist-managed, home-based intervention for people with Parkinson disease, with the potential to improve gait, balance, and fall-risk indicators. Findings on the integration of AR cueing highlight the importance of an individualized approach.

RELEVANCE: Implementing AR rehabilitation technologies like Strolll in the clinical pathway is feasible, offering a safe and scalable way for individuals to train independently, potentially improving accessibility of care and broadening its use to physical activity promotion.

CLINICAL TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov (NCT06590987).